md-medicaldata


Go to content

OPTIČKA KOHERENTNA TOMOGRAFIJA METODA IZBORA U MALAPOZICIJI STENTA /
OPTICAL COHERENT TOMOGRAPHY METHOD OF CHOICE IN STENT MALAPOSITION

Authors

 

Vladimir Ivanović1,2, Dragana Dabović2, Milenko Čanković1,2, Anastazija Stojšić-Milosavljević 1,2, Milovan Petrović1,2, Maja Stefanović1,2, Aleksandra Ilić1,2, Snežana Tadić1,2

1Univerzitet u Novom Sadu, Medicinski fakultet Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, R. Srbija
2Institut za kardiovaskularne bolesti Vojvodine, Klinika za kardiologiju, Put doktora Goldmana 4, 21204 Sremska Kamenica, R. Srbija

 

UDK: 616.12-005.6-073


The paper was received / Rad primljen: 09.04.2019.

Accepted / Rad prihvaćen: 15.05.2019

 


Autor za korespondenciju:


doc. dr Vladimir Ivanović
Klinika za kardiologiju, Institut za kardiovaskularne bolesti Vojvodine,
Put doktora Goldmana 4
21204 Sremska Kamenica
e-mail: vladimir.ivanovic@mf.uns.ac.rs

 

 

Sažetak

 

Uvod. OCT i IVUS predstavljaju modalitete intravaskularnog imidžinga. OCT-om se mogu dobiti dragoceni podaci o različitim pojavama unutar zida i lumena krvnoga suda. Po jednoj od definicija malapozicija stenta je prisutna kada je aksijalna distanca između spoljašnje površine strata stenta i luminalne površine krvog suda veća od debljine strata stenta. Prikaz slučaja. Muškarac dobi 51 godinu juna 2017. godine primljen je zbog STEMI prednjeg zida. Radi se o kompleksnom koronarnom bolesniku, kome je  u dva navrata rađena  PCI  na LAD. Po prijemu juna meseca 2017. godine urađena je rekoronarografija kojom se nađe okluzija LAD u predelu ranije implantiranog stenta-kasna tromboza stenta. Urađene su višestruke balon dilatacije sa NC balonom. Po uspostavljanju TIMI III protoka kroz LAD uradjena je OCT analiza kojom se nađe  malapozicija u proksimalnom delu stenta preko 300 mikrona. Zaključak. Prilikom tretmana ovakvih bolesnika neophodno je pokušati utvrditi uzrok pojave tromboze, a jedini pravi način je primenom intravaskularnog imidžinga.  U slučajevima kasne i veoma kasne tromboze stenta u analizu treba uzeti i pokrivenost stratova stenta sa endotelom za koje je neophodno vreme.  U jednom od novijih OCT istraživanja čiji je cilj bio determinisanje uzroka veoma kasne tromboze stenta glavni uzrok tromboze  u 29.3% slučajeva bila je malapozicija i nepokrivenost stratova stenta endotelom. U našem slučaju radi se o velikom stepenu malapozicije stenta, što je najverovatnije uzrok pojave akutnog STEMI.
Kao što preporuke o revaskularizaciji miokarda govore, kada je moguće treba koristi intravaskularni imidžing radi definisanja uzroka. Zbog svojih prednosti u rezoluciji slike i preciznosti prednost treba po našem mišljenju dati optičkoj koherentnoj tomografiji.

 

 

Ključne reči:

optička koherentna tomografija, stent, malapozicija, intravaskularni imidžing

 

 

Abstract

 

Introduction. OCT and  IVUS are a modality of intravascular imaging. OCT can provide valuable data on various occurrences within the wall and lumen of the blood vessel.   According to one of the definitions, stent malaposition is present when the axial distance between the outer surface of the strata of the stent and the luminal surface of the blood vessel is greater than the thickness of the strata of the stent.
Case Report. A 51-years-old men in June 2017 was admitted because the STEMI anterior wall. It is a complex coronary patient, two times the PCI was done on the LAD.  Upon receipt in June of 2017, a recoronarography was performed and the occlusion of LAD in the area of previously implanted stent-late stent thrombosis was found. Multiple balloon dilations with NC balloon were made. After establishing TIMI III through LAD, an OCT analysis was performed to find malaposition in the proximal part of the stent over 300 microns. Conclusion. When treating this patients it is necessary to try to determine the cause of thrombosis, and the only correct way is  using intravascular imaging. In the cases of late and very late stent thrombosis in the analysis, the coverage of the stent with endothelium should be taken for which time is needed. In one of the recent OCT studies, whose goal was to determine the cause of a very late stent thrombosis, the main cause of thrombosis in 29.3% of cases was malaposition and non-coverage of stentions with stent endothelium. In our case, there is a high degree of stent malaposition, which is most likely the cause of acute STEMI. As recommendations on myocardial revascularization speak, whenever possible, intravascular imaging should be used to define the cause. Because of its advantages in image resolution and precision, the advantage should in our opinion be given to optical coherent tomography.

 

 

Keywords:

optical coherence tomography, stent, malapposition, intravascular imaging

 

 

References:

 

  1. Neumann F‑J, Sousa-Uva M, Ahlsson , Alfonso FBanning APBenedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165.

Prati FRegar EMintz GSArbustini EDi Mario CJang IK, et al.  Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J. 2010;31(4):401-15.

  1. Armstrong EJ, Feldman DN, Wang TY, Kaltenbach LA, Yeo K-K , Wong SC, et al. Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC Cardiovasc Interv. 2012;5(2):131–40.
  2. Waksman RKitabata HPrati FAlbertucci MMintz GS. Intravascular ultrasound versus optical coherence tomography guidance. J Am Coll Cardiol. 2013;62(17):S32-40.
  3. Mori HJoner MFinn AVVirmani R. Malapposition: is it a major cause of stent thrombosis? Eur Heart J. 2016;37(15):1217-9.
  4. Hiroyoshi M, Diljon C, Aloke VF. Pathological and Observational Assessment of the Early, Late, and Very Late Outcomes Related to Stent Malapposition.  2017 .  
  5. Foin N, Gutiérrez-Chico JL, Nakatani S, et al. Incomplete stent apposition causes high shear flow disturbances and delay in neointimal coverage as a function of strut to wall detachment distance: implications for the management of incomplete stent apposition. Circ Cardiovasc Interv. 2014;7:180-9.
  6. Taniwaki M, Radu MD, Zaugg S, et al. Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography. Circulation. 2016;133(7):650-60.
  7. Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, et al.; ESC Scientific Document Group. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2018; 39(35):3281–300.


PDF Ivanović V. et al. • MD-Medical Data 2019;11(2): 099-102

 

 

 

Naslovna | Revija | Galerija | Dešavanja | Instrukcije | Redakcija | Izdavač | Prijatelji sajta | Saradnja | Kontakt | Site Map


Back to content | Back to main menu